Mexico: Children still toil in tobacco fields as reforms fail to fix poverty

Opinion: How we can fight child labour in the tobacco industry

Opinion: Stop rising tobacco use in Africa and the Middle East

UK

North-East: NHS not doing enough to help smokers, says Fresh

The tobacco control group Fresh, thetobacco control programme in the North-East, has backed calls from the Royal College of Physicians for the NHS to offer smokers routine support to quit when they receive hospital care, regardless of their condition.

Fresh said it would support the broader work led by local authorities and complement their local community stop smoking services.

Ailsa Rutter, Director of Fresh, said: “Smoking is our biggest killer and cause of ill health. “Our doctors, nurses and GPs are in a unique position to alter the course of a patient’s long term health and help them to quit. Not doing so means we are failing our patients. The evidence is strong that helping smokers to stop is very cost effective, saves lives and will save the NHS millions of pounds, and will help the North-East get to a point when five per cent or fewer people smoke.”

Around £12,000 of illegal cigarettes and tobacco has been seized after raids on several properties.

Cheshire East Council’s trading standards officers have carried out the operations, with the aid of sniffer dogs, at premises in Crewe and Macclesfield. More than 50,000 cigarettes were discovered after they had been concealed in places such as a false wall, in light fittings and under floor boards. The seizure followed a tip-off that cigarettes were secretly being stored in a number of residential and business locations.

Councillor Janet Clowes, Cheshire East Council cabinet member with responsibility for safer communities, said: “As an enforcing council, we work hard to keep harmful products off the streets and will crack down on businesses, criminal gangs or individuals who flout the law. All tobacco is harmful but the illegal black market in tobacco, and in particular the availability of cheap cigarettes, makes it harder for smokers to quit and remain smoke free.

Local primary schools took part in tobacco workshops, led by the East Dunbartonshire Tobacco Alliance, before participating in a competition to design a poster to deter smoking within play parks, urging adults not to smoke where children play. The winning poster will soon be displayed in all parks across Bishopbriggs and Auchinairn in the latest drive to stamp out smoking in East Dunbartonshire.

Smokefree play parks have already been created in Bearsden, Kirkintilloch, Milton of Campsie, Bishopbriggs and Auchinairn. It is hoped that the project will be rolled out to all 67 play areas in East Dunbartonshire.

Britons strongly support interventions on health issues, a survey suggests. The briefing, produced for the BBC, found that almost three quarters (72%) supported the ban on smoking in public spaces. The paper concludes that there is “surprisingly strong public support for these types of intervention”.

The authors, from The King’s Fund, the Health Foundation, the Institute for Fiscal Studies and the Nuffield Trust, added: “If government is serious about improving the public’s health, it must do more to tackle the wider determinants of health through a more co-ordinated approach to policy-making.”

Helen McKenna, senior policy adviser at The King’s Fund, said: “It is essential that national and local government use all the means at their disposal to improve the public’s health.
This should include being bolder in using tax and regulation where this can be effective. Although politicians may balk at the idea of the ‘nanny state’, our research suggests these types of intervention may enjoy stronger public support than they often assume.”

In the first systematic review to focus on children’s SHS exposure at home before and after the introduction of smoke-free legislations, Sarah Nanning and colleagues at the University of Bremen, Germany, have looked at 15 studies which were published between 2007 and 2016.

The studies all included proportions of children (most aged between 5 and 15 years) exposed to SHS at home before and after the introduction of smoke-free legislation. Sample sizes ranged from 118 to 68,000 participants.

The findings indicate that children’s SHS exposure at home did not increase after the introduction of public smoking bans. The comprehensive laws (those that require worksites, restaurants, and bars to be smoke-free) and mixed smoke-free laws (where there are regional differences in the type or extent of public smoking bans within a country or with an exceptional rule for certain types of hospitality venues such as small bars) all yielded reductions of SHS exposure at home.

Nearly a quarter of Asian men smoke cigarettes, and lung cancer among Chinese men in New York City has increased by 70% over the past 15 years, according to the city’s health department.

Targeting Chinese men in particular, the department launched a public service campaign earlier this month encouraging them to quit the habit. The city has started running public service ads in Cantonese and Mandarin on Chinese-language television and in newspapers.
Chinese smokers can get free quit-smoking medication and confidential counselling from the Asian Smokers’ Quitline — a nationwide service funded by the Centres for Disease Control and Prevention.

“We have made considerable progress in driving down the rates of smoking among adults, but Chinese men still have disproportionately high rates of smoking,” said Dr. Mary T. Bassett, the city’s health commissioner. “We hope this campaign motivates Chinese men to quit smoking — it is the most important thing they can do to improve their health.”

Mexico: Children still toil in tobacco fields as reforms fail to fix poverty

A series of exposés in the 1990s in Mexico revealed widespread use of child labour and banned agrochemicals, and detailed abysmal living and work conditions in Nayarit’s tobacco fields. Industry and government have since made steps to tackle child labour in Mexico’s tobacco fields, but low incomes for working families slows this progress.

In an effort to eradicate Mexico’s child labour, the Prospera scheme, launched in 1997, offers small cash incentives to impoverished parents to keep children in school and attend health checks and workshops on nutrition, hygiene and family planning. The government paid out $500m to 6.1 million families in 2016, but audits suggest the impact on child labour has been modest. No matter how hard some families try to get away from these plantations, poverty drags them back.

Jennie Gamlin of University College London, who investigates structural violence and health inequalities, said: “Tobacco workers are the poorest of the poor forced to work and live in poor conditions which expose them to preventable harms that reproduce inequalities. Parents know that it is harmful and wrong according to law for children to work in tobacco, but they’re poor, need the money and don’t see another option. Even when the kids aren’t working, they are playing and sleeping within the tobacco.”

Many of the world’s most popular brands of cigarettes may contain tobacco produced by vulnerable child workers. The world’s largest multinational tobacco product manufacturers, including the UK giants British American Tobacco (Lucky Strike, Camel, and Dunhill) and Imperial Brands (Davidoff and Gauloises Blondes), say that they are doing everything they can to end exploitative child labour, stop abuses in their supply chains and have policies to safeguard workers.

Human Rights Watch has been in regular contact with many tobacco companies since we started this work. Several companies have adopted new policies or strengthened existing polices to prohibit suppliers from allowing children to do dangerous tasks on farms. But no company prohibits those under 18 from all work involving direct contact with tobacco in any form – the policy that would offer the greatest protection, in line with international standards.

Most companies maintain that their policies are carried out throughout global supply chains, but we believe many do not report transparently about their monitoring and what they find. Without this information, we have to take their word for it that they’re doing enough to address rights abuses in their supply chains. Companies should provide credible, transparent information on human rights problems and steps they take to fix them.

Source: Margaret Wurth and Jane Buchanan of Human Rights Watch in The Guardian, 27 June 2018

As tobacco use has steadily declined in most of the world, two large regions are bucking the trend. In the Middle East and Africa, 180 million men are predicted to be smoking by 2025 — twice as many as in 2000. To reverse this, governments need to more firmly confront the tobacco industry’s efforts to recruit the next generation of smokers.

Few Middle Eastern and African countries have fully imposed and enforced a comprehensive suite of tobacco control measures, such as raising tobacco taxes; requiring large graphic health warnings on cigarette packs; prohibiting smoking in restaurants and other public spaces; and banning tobacco advertising.

Tobacco use is the single greatest preventable cause of death. Public health specialists in developed countries have spent decades learning how to fight back — and have saved lives by the millions. Countries in the Middle East and Africa need to follow suit.

Daily Mail – coverage of RCP report: Patients ‘should be recommended e-cigarettes as a way to quit smoking and be allowed to use them at hospitals’

UK

Wales: Ospreys back anti-smoking campaign at sports grounds

International

Child labour rampant in tobacco industry

BMJ blog: The Kuala Lumpur Charter on Smoke-Free Homes

Release of RCP report and newspaper responses

Royal College of Physicians (RCP) releases ‘Hiding in plain sight, Treating tobacco dependency in the NHS’

Hiding in plain sight: Treating tobacco dependency in the NHS demonstrates that clinicians working in almost all areas of medicine will see their patients’ problems improved by quitting smoking, and that systematic intervention is a cost-effective means of both improving health and reducing demand on NHS services. Smoking cessation is not just about prevention. For many diseases, smoking cessation represents effective treatment.

It calls on doctors to recognise that recognising and treating tobacco dependence is their business, and to incorporate smoking cessation as a systematic and opt-out component of all NHS services, delivered in smoke-free settings.

The Times – coverage of RCP report: Help smokers quit, doctors tell hospitals

The NHS’s failure to help smokers quit is “as negligent as not treating cancer”, top doctors say.

Sanjay Agrawal said: “This is an open goal for the NHS. We can save lives and save money by applying simple effective treatments in the same way that we do for millions of other patients — these treatments are very low cost. The changes would be pretty straightforward to make and we would start reaping the benefits in the first year, taking some of the strain off the NHS. The changes we have recommended have been tried and tested in the UK and Canada and have made a significant impact, so it’s time to apply this approach across the NHS.”

Smokers “put a particular strain on the NHS”, the college warned, with a 36% greater likelihood of being admitted to hospital.

Professor John Britton, chairman of the Tobacco Advisory Group, said: “Smoking, the biggest avoidable cause of death and disability in the UK, is hiding in plain sight in our hospitals and other NHS services; the NHS must end the neglect of this huge opportunity to improve our nation’s health.”

Lost productivity from smoking breaks alone cost £99m with total per smoker approaching £3,000 a year.

NHS staff smoking habits cost the health service more than £200m a year in cigarette breaks, sick days and treatment, a report on the £1bn a year avoidable cost of tobacco dependency has found.

There are more than 73,000 smokers among the 1.2 million NHS employees in England and the lost working hours from their combined smoking breaks add up to £99m a year, the Royal College of Physicians’ tobacco advisory group has said.

Smokers also had 56 per cent more sick days, amounting to £101m in NHS costs, and cost £6m in treating staff with preventable diseases caused by tobacco. In total, the RCP panel said, this amounts to £2,800 per staff smoker.

Professor John Britton, the chair of the RCP tobacco advisory group, told The Independent: “The NHS must end the neglect of this huge opportunity to improve our nation’s health.”

Daily Mail – coverage of RCP report: Patients ‘should be recommended e-cigarettes as a way to quit smoking and be allowed to use them at hospitals’

Patients should be recommended e-cigarettes as a way to quit smoking and be allowed to use them at hospitals, doctors’ leaders say. They are calling for patients to be routinely offered help in kicking the habit at GP appointments, outpatient clinics and when admitted to hospital.

The NHS’s failure to help smokers quit is as serious as not treating cancer patients, they added. The recommendations have been drawn up by the Royal College of Physicians which has accused the NHS of being ‘negligent’ in not doing enough to help smokers quit.

The Welsh rugby club Ospreys have put their weight behind a campaign by ASH Wales for local sport clubs to adopt no smoking policy at their playing fields. Although most Welsh stadiums have become smokefree zones, many grounds where children train and play have yet to follow suit.

The Ospreys in the Community will work with the charity to encourage regional clubs to adopt a no smoking policy with the aim of protecting young players from being influenced to smoke.
The club will promote the initiative at a beach rugby festival in front of 600 kids.

Child labour in tobacco is widespread and on the increase in poorer countries, a major Guardian investigation has revealed, in spite of claims by multi billion-dollar companies that they are tackling the issue.

Evidence from three continents shows how children aged 14 and under are kept out of school and employed in hard and sometimes harmful physical labour to produce the tobacco leaf that fills cigarettes sold internationally, including in the UK, US and mainland Europe.

Families are trapped in generational poverty while salaries at the top of the industry run to millions of dollars a year. The companies say they monitor child labour and remove children from the fields to go to school, but experts have told the Guardian that the numbers are going up, not down, as tobacco growing increases in Africa and Asia.

In accordance with article 8 of the Framework Convention on Tobacco Control, governments, health practitioners and wider society all have a duty to protect non-smokers from the harms caused by second-hand tobacco smoke (SHS) exposure. Considerable attention over the past two decades has been given to implementing smoke-free public spaces and workplaces in many countries.

However, there is the risk that the tobacco control and wider public health research community now wrongly perceives that the ‘SHS exposure problem’ has been successfully resolved and no longer requires international attention. It is possible that this has caused a widening in exposure inequality with adults in countries where smoke-free laws are comprehensive benefitting most while children in poorer communities in those countries where smoke-free laws are partial or poorly enforced have seen almost no improvement.

In the week of its AGM, ASH is urging British American Tobacco (BAT) to stop turning a blind eye to child labour and unacceptable working conditions on Zimbabwean tobacco farms which supply 6% of the company’s tobacco leaf.

BAT’s ‘Supplier Code of Conduct and Child Labour Policy’, published in 2016, outlined its commitment to ensuring a safe working environment and prohibiting child labour. Yet a report from Human Rights Watch published this month entitled ‘A Bitter Harvest’ finds farmers in Zimbabwe are ill-informed of the risks associated with nicotine exposure, and are not receiving the necessary training or equipment to protect themselves. [1]

As a result, many tobacco farmers reported symptoms consistent with acute nicotine poisoning, such as sickness and dizziness, which happens when workers absorb nicotine through their skin while handling tobacco plants. Others claimed they were pushed to work excessive hours without overtime compensation, denied their wages, and forced to go weeks or months without pay.

This ill-treatment is not confined to adults. BAT’s code specifically identifies hazardous tasks which under 18’s should not perform in tobacco farming. These include harvesting, topping and suckering. Yet child labour continues to be widespread within the tobacco industry in Zimbabwe, with many under 18s working in conditions that threaten their health and safety or interfere with their education. Children are more vulnerable to nicotine poisoning than adults, and new evidence also shows that children are, in some cases, mixing, handling, or applying pesticides directly to crops, putting them at further risk. Compounding this, children who engaged in tobacco farming were frequently absent from school during the tobacco growing season, causing them to fall behind with school work.

Most workers said that, as far as they knew, union organizers were the only people to inspect conditions at their workplaces and speak with them about grievances. Very few of the hired workers on small or large-scale farms who were interviewed said they had ever seen a labour inspector or other government official visit their workplace to inspect working conditions.

In response to criticisms from Human Rights Watch about the rigour and effectiveness of BAT’s implementation of its code, the company said a revised audit system due to be implemented in 2018 would include visits to tobacco farms and in-depth analyses of suppliers’ policies, processes, and practices. However, the on-site review will only last four days, with only one day of field visits. It also does specify how many auditors are involved in these visits or how many farms will be visited. BAT has also committed to ‘undertake an interim review on human rights via unannounced farm visits by BAT to Zimbabwe farms, planned for early 2018’, but what this will amount to has never been made clear.

These are fine words, but the track record to date in Zimbabwe does not encourage confidence, and BAT’s processes lack transparency or detail. BAT must go a great deal further, and commit to adopting the recommendations set out in the Human Rights Watch report. To do less is unacceptable.

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